| 摘要: | 背景:入住長照機構的老年人數逐年增加。照服員佔所有長照機構工作人員56%，是提供最直接照護，被視為優良照護品質的關鍵。隨著住民的疾病複雜性和依賴性增加，照服員易有匆促執行照護或遺漏照護的情形，降低了工作滿意度和留任率。遺漏照護影響照護品質在國外急性醫療已有討論，但僅有少數文獻探討長照機構照服員在執行住民照護的遺漏。
目的:了解長照機構照服員執行住民照護時的遺漏率、原因及與照護品質和員工滿意度、離職意願之相關性探討。
研究方法:採用橫斷式調查研究，使用研究者擬定的照服員、護理人員和機構管理者問卷，包含個人基本資料、機構特性、工作滿意度量表、遺漏照護量表、和機構五項品質指標。遺漏照護量表分為照服員遺漏照護率和照服員遺漏照護原因兩部份，由照服員和護理師分別填寫覺得機構內照服員在最近7個工作日中遺漏照護情形和遺漏照護的原因。以立意取樣調查北部和中部共5家護理之家及5家養護機構的照服員、護理人員、護理主管，共收案照服員184人、護理師80人及機構管理者10人。
結果:1.遺漏率為偶而遺漏或以上的百分率以「協助身體清潔」(30.4%)最高，其次為「提醒或協助洗手」(22.7%)、「協助執行復健活動」(22.4%)。36.41%的照服員和77.5%的護理師覺得機構內照服員在最近7個工作日中曾至少有一項工作偶而或以上之遺漏，顯示照服員和護理師對於執行照護工作內容的認知不同。所有遺漏照護平均值皆為護理師感受到的比照服員的多，平均多0.52分。2.遺漏照護原因大於等於2分的百分比以「住民病況惡化」(74.2%)為最高，其次為「照服員間漏交班」(72.7%)、「照服員人數不足」(69.3%)。遺漏照護原因三面向中90.2%的照服員和護理師表示溝通不良造成遺漏照護，89.8%表示人力資源不足造成遺漏照護，64%表示物質資源不足造成遺漏照護。3.遺漏率中「本國籍」照服員較高(t=3.484, p=.001)；「偶而有足夠人力」、「從未有足夠人力」較「總是有足夠人力」遺漏率高(F=5.388, p=.000)。4.機構特性與長照機構照服員遺漏照護率無顯著相關(p>.05)。5.遺漏照護率與「最近12個月平均壓瘡點盛行率」有低度正相關(r=.131, p=.034)，與「最近12個月平均總感染發生密度」、「最近12個月平均下呼吸道感染率」、「最近12個月平均泌尿道感染率」、「最近12個月平均跌倒發生率」無明顯相關(p>.05)。6.遺漏照護率與「對目前工作的滿意度」、「對單位的團隊合作程度的滿意度」為低度負相關，與近期離職意願無顯著差異(p>.05)。
結論與應用:1.更改工作流程，讓照服員不會遺漏這些項目，將可有效改善照護品質。2.遺漏照護原因最主要為「照服員間漏交班」，設計方便交班方式，提升照服員交班正確性與持續性。3.在本研究中，遺漏照護率與最近12個月平均總感染發生密度、下呼吸道感染率、泌尿道感染率、跌倒發生率無明顯相關，但在國外文獻則有顯著相關，建議可繼續繼續探討此議題。
Background: The amount of elderly people living in nursing homes has increased by the year. Nursing aides account for 56% of nursing home staff and directly provide nursing care. They are deemed the key in offering quality nursing care. As the complication and dependency of nursing home residents rises, rushed or missed nursing care occurs. This lowers job satisfaction and retain rate. The effects of missed nursing care on nursing quality has already been subject to discussion in foreign emergency medicine but very little literature reviews the nursing care that is missed by nursing home aides.
Objectives: Understand the missed rate of nursing home aides when executing nursing care for residents, the reason, care quality and their relevance to job satisfaction of the staff and the review of their relevance to.
Methods: Adopts cross-sectional study and uses the nursing aide, nursing personnel and nursing home management surveys designed by the researcher, include basic personal information, nursing home attributes, job satisfaction chart, The MISSCARE Survey and five quality indicators. The MISSCARE Survey is divided into two parts – Missed Nursing Care Frequency & Reasons for nursing aides. The nursing aides and the nurses are responsible for the feedback on the missed nursing occurrences of the nursing home and what they deem the reasons for missed nursing care in the last 7 working days. The research studies a total of 10 nursing homes in northern and central Taiwan, 184 people who are nursing aides, 80 people who are nurses, as well as 10 nursing home management.
Results: 1. Missed nursing care items with Occasionally missed frequency or higher, “assist in body cleaning” (30.4%) was the highest, followed by “Remind or assist to wash their hands.” (22.7%) and “Assist in daily rehabilitation activities”(22.4%). 36.41% of the nursing aides and 77.5% of the nurses deem there to be at least one occurrence of occasionally missed nursing care in the last 7 working days. This indicates that nursing aides and nurses have different cognition in terms of the contents of nursing work. The missed nursing rate was on average higher for nurses that nursing aides by 0.52 points. 2. The percentage rate for the cause of missed nursing care was higher than 1 point, “Resident’s emergency situations”(74.2%) was the highest, followed “The job could not be handed over to the next shift” (72.7%), “There are not enough nursing aides”(69.3%). 90.2% of nursing aides and nurses deem improper communication to be the cause of missed nursing care. 89.8% claimed lack of manpower resulted in missed nursing care. 64% claimed lack of resources resulted in missed nursing care. 3. The missed nursing care rate has “domestic” nursing aide as the highest (t=3.484, p=.001); “Manpower is sometimes enough, “Manpower is never enough” has a higher missed nursing care rate than “Manpower is always enough”(F=5.388, p=.000).4. There is no significant connection between the nursing home’s attributes with the missed nursing care rate of the nursing aides (p>.05). 5. The missed nursing rate has minimal correlation with “average pressure sore prevalence rate of the past 12 months”(r=.131, p=.034), has no obvious correlation to “Average overall infection density of the past 12 months”, “average respiratory infection rate of the past 12 months”, “average urinary tract infection rate of the past 12 months”, “average fall occurrence rate of the past 12 months” (p>.05). 6. Missed nursing care rate has low negative correlation with “current job satisfaction”, “satisfaction for team cooperation”.
Conclusion and application: 1. Improvement of work procedures, ensuring that these items are not missed can effectively improve nursing care quality. 2. The main reason for missed nursing care is “The job could not be handed over to the next shift”. Electronic bedside systems can be implemented to rapidly inform nursing aides on the current nursing needs of the residents in addition to enhancing the precision and continuity of nursing aides shifts. 3. Within this study, the missed nursing care rate has no obvious connection to the average overall infection density, infection rate of lower respiratory system, infection rate of urinary tract infection and fall occurrence rate. However, significant correlation is documented in foreign literature. Further review of this issue is recommended. |
